Traditional, positivist assessment approaches generally fail to capture the nuances of learners’ clinical competence in medical programmes. This has led to the implementation of an alternate assessment approach known as ‘programmatic assessment’, which embraces subjectivity of human judgement in holistic decision making in clinical settings. Faculty and staff have found the introduction of programmatic assessment to be challenging because it is a major, complex change to the traditional way of carrying out assessment. Extending our previous work, where we used critical (...) realism to explore students’ experiences of programmatic assessment, we here unpack the underlying conditions and mechanisms triggered by programmatic assessment’s implementation. We applied Bhaskar’s concept of ontological stratification, retroduction and Archer’s theoretical accounts of morphogenesis/stasis to theorize the interplay between the socio-cultural entities that constrain and enable desired changes in assessment practices, and those that condition students and staff to accept or reject the new ‘non-traditional’ assessment processes. (shrink)

Contemporary bioethics education has been developed predominately within Euro-American contexts, and now, other global regions are increasingly joining the field, leading to a richer global understanding. Nevertheless, many standard bioethics curriculum materials retain a narrow geographic focus. The purpose of this article is to use local cases from the Asia-Pacific region as examples for exploring questions such as ‘what makes a case or example truly local, and why?’, ‘what topics have we found to be best explained through local cases or (...) examples?’, and ‘how does one identify a relevant local case?’ Furthermore, we consider the global application of local cases to help extend the possible scope of the discussion, opening new avenues for the development of practical bioethics educational materials. We begin with a background description and discussion of why local cases enhance bioethics education, move to an overview of what is currently available and what is not for the region, and then outline a discussion of what it means to be local using example cases drawn from Hong Kong, Australia, Pakistan, and Malaysia. We are not creating a casebook but rather constructing by example a toolbox for designing active and dynamic learning cases using regional diversity as contextualised cases with generalised principles. (shrink)